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February 13, 2017

There are three "balls in the air" so to speak for health insurance costs and coverages, and each one comes back to costs: The costs of medical care, patients' costs, and government costs. For any new proposal to replace the Affordable Care Act a/k/a "Obamacare" (and there will be many), look for how it handles the costs of medical care.

The current proposals include all or some combination of the following measures:

Higher deductibles and co-pays paid by patients. Higher deductibles and co-pays do not lower the costs of medical care.

Cost-sharing which reduces government costs with a corresponding increase in patients' costs. (The twin effects of cost-sharing, where it has been implemented, are that it causes patients to (1) skip necessary treatments or (2) cut back on prescribed medicines, and (3) both.) Cost-sharing does not reduce the costs of medical care.

Narrower physicians networks, such that with fewer physicians to choose "in network" patients' costs go up whenever they cannot find treatment in the narrow limits of the carrier's "network" and so the patient pays more going "out of network." Narrower physicians networks do not reduce the costs of medical care.

Return to the pre-existing condition exclusion. Again, the only group that pays more under this measure is the only group containing the people who need medical care: Patients. The pre-existing condition exclusion bars coverage for the costs of medical care for pre-existing conditions. Period. Moreover, government costs for healthcare are reduced substantially while patients' costs for healthcare are increased substantially. The pre-existing condition exclusion never reduced the costs of medical care and it will not reduce the costs of medical care now.